Chronic total occlusion of left main coronary artery

ABSTRACT

A 64 years old diabetic male underwent diagnostic coronary angiography for stable angina [Canadian Class II] of 6 months duration. He had only one episode of prolonged rest angina two months prior to presentation. Electrocardiogram was abnormal for complete right bundle branch block with left anterior fascicular block and Q-wave anteroseptal myocardial infarction. Coronary angiography revealed total occlusion of the distal LMCA with minimal antegrade flow in the left coronary system beyond the occlusion. The right coronary artery [RCA] had 90% stenosis in the posterolateral branch and supplied collateral circulation to the left coronary arteries with retrograde filling of left anterior descending [LAD] and left circumflex [LCX]. The patient underwent urgent CABG. Revascularization was performed with left internal mammary artery anastomosed to LAD and vein grafts to LCX and RCA. The postoperative course remained uneventful with early discharge and the patient is currently asymptomatic undergoing cardiac rehabilitation